van Immerzeel Tabitha D, Camara Maty D, Deme Ly Indou, de Jong Rosemarijn J
Centre Médico-Social Keru Yakaar, Dakar, Senegal.
Head of department Nutrition and Alimentation at the Ministry of Health, University Cheikh Anta Diop, Dakar, Senegal.
BMC Health Serv Res. 2019 Jan 25;19(1):69. doi: 10.1186/s12913-019-3903-x.
Treatment of acute malnutrition in infants under 6 months is a relevant topic regarding the global problem of maternal and child malnutrition. While treatment for older age groups has shifted more towards an outpatient, community based approach, young infants are mostly treated in hospital. This study aims to describe barriers and facilitators for outpatient and inpatient treatment of malnourished infants under 6 months in Senegal.
This qualitative descriptive study uses in-depth interviews with health workers and focus group discussions with mothers of malnourished infants, conducted from June to September 2015 in two case clinics. In data analysis, Collins' 3 key factors for a successful nutrition program were used as a theoretical framework: access, quality of care and community engagement.
Within Collins' 3 key factors, 9 facilitators and barriers have emerged from the data. Key factor access: Outpatient care was perceived as more accessible than inpatient concerning distance and cost, given that there is a milk supplement available. Trust could be more easily generated in an outpatient setting. Key factor quality of care: The cup and spoon re-lactation technique was efficiently used in outpatient setting, but needed close supervision. Basic medical care could be offered to outpatients provided that referral of complicated cases was adequate. Health education was more intensive with inpatients, but could be done with outpatients. Key factor community engagement: The community appeared to play a key role in treating malnourished young infants because of its influence on health seeking behaviour, peer support and breastfeeding practices.
Outpatient care does facilitate access, provided that an affordable milk supplement is available. Quality of care can be guaranteed using an appropriate re-lactation technique and a referral system for complications. The community has the potential to be much engaged, though more attention is required for breastfeeding education. In view of the magnitude of the health problem of young infant malnutrition and its strong relationship with breastfeeding practices, an outpatient community-based treatment approach needs to be considered.
6个月以下婴儿急性营养不良的治疗是母婴营养不良这一全球问题的相关议题。虽然针对年龄较大群体的治疗已更多地转向门诊和基于社区的方法，但小婴儿大多在医院接受治疗。本研究旨在描述塞内加尔6个月以下营养不良婴儿门诊和住院治疗的障碍与促进因素。
这项定性描述性研究采用了对卫生工作者的深入访谈以及与营养不良婴儿母亲的焦点小组讨论，于2015年6月至9月在两家病例诊所进行。在数据分析中，将柯林斯成功营养项目的3个关键因素用作理论框架：可及性、护理质量和社区参与。
在柯林斯的3个关键因素中，数据中出现了9个促进因素和障碍。关键因素可及性：鉴于有牛奶补充剂，门诊护理在距离和成本方面被认为比住院护理更容易获得。在门诊环境中更容易建立信任。关键因素护理质量：杯勺再喂养技术在门诊环境中得到有效应用，但需要密切监督。只要对复杂病例的转诊得当，就可以为门诊患者提供基本医疗护理。对住院患者的健康教育更密集，但也可以对门诊患者进行。关键因素社区参与：社区在治疗营养不良的小婴儿方面似乎发挥着关键作用，因为它对就医行为、同伴支持和母乳喂养习惯有影响。
只要有负担得起的牛奶补充剂，门诊护理确实有助于提高可及性。使用适当的再喂养技术和并发症转诊系统可以保证护理质量。社区有很大的参与潜力，不过母乳喂养教育需要更多关注。鉴于小婴儿营养不良这一健康问题的严重程度及其与母乳喂养习惯的密切关系，需要考虑基于社区的门诊治疗方法。
